Those of us who survive this pandemic will be living in a changed world. It's up to each one of us to make decisions and take actions that will determine whether our "new normal" is more just and more equitable than the old one. - -Aswita Tan-McGrory

Tam-McGrory reminds us-if we in health move to right past wrongs, perhaps other parts of society will follow.1 My hope is that she is right. Indeed, it is time-past time-for this reckoning. As a society, we are well overdue to become more tolerant, more aware, more inclusive. Perhaps we did not have the words, the insight, or the courage to see what we allowed to be invisible. Inequities in health care existed well before COVID-19 unveiled the stark realities in what are now considered ordinary times. Nevertheless, many inequities were often missed or ignored.

We have heard our patient stories, and we know the challenges that many of our patients face, well beyond the physical signs and symptoms that we so competently address. We know that care is disproportionally distributed, even within the protected walls of our organizations. Too often, care crumbles in the face of health disparities and societal inequities.

Compassion is a constant presence, but it has not been enough; only a new direction will create a more equitable society. And only in an equitable society will health thrive, and our care be whole.

What will each one of us do to make different decisions and take different actions to make sure that we are not complacent? In a postpandemic world, we have an opportunity to do everything differently, including disavowing racial injustice and inequities in health care. COVID-19 will be remembered as the great pandemic of our generation, but more importantly, it will be an accelerator of change. The global threat united us, but also illuminated glaring injustices in health disparities, as political and racial unrest raged. This awareness brought forth new aims, adding depth to our goals.

Introducing the Quintuple Aim

Derek Feeley, a past president of the Institute for Healthcare Improvement (IHI), tells us it has been a time of tragedy and opportunity as these new challenges have presented a chance to build new systems and structures with equity as a crucial component.2 In this moment of clarity, the IHI has announced a new aim, a long overdue vector to expand the triple aim, illuminate the quadruple aim, and introduce the Quintuple Aim! The Triple Aim-improving population health the care experience and reducing costs-was first described in 2008. This model provided me, and all of us, with a vision of health care that made sense and guided our work. This was later enhanced by a fourth aim-finding joy and value in work. Clearly, this was a target aim to reduce burnout and profession dissatisfaction.

Now, an opportunity exists and demands that another contributing and reinforming aim complete the vision. A fifth aim is to advance health equity. This does not add complexity to the model as the reasoning behind adding a fifth aim is that none of the previous aims can be met without health equality as an explicit goal. The addition of the fifth aim simply implores us to identify disparities and invest in equality measurement and interventions.

Recently, Nundy et al3 coauthored a call to action in a recent opinion piece, compelling us to acknowledge the profound health inequities in our society They tell us that this work will include moving beyond traditional demographic identifiers to recognize all underlying causes of inequities, such as discrimination, mistrust, food and housing insecurity, and, yes, racism.3

More than a year after the death of George Floyd, the pandemic continues; we grieve for the unimaginable loss of life; many represent the most vulnerable among us. Political unrest complicates health care, even as we are still grappling with the disproportionate loss of life for our most vulnerable people. Economic and health disparities are glaring-no longer invisible.4 No longer silent-we can say the words: inequity, racism[horizontal ellipsis] we can admit to failure; we can pledge to do better, be better.

Tan-McGrory's1 writing reflects our own unspoken thoughts: "One thing I realized is that there is a silence in our community about the hate, discrimination, and racism we face daily. Racism is so complex, insidious, and pervasive that to take a binary view of it is to miss the bigger picture." She encourages us to look more closely at the historical and social context of this time to examine the root cause of racial and ethnic disparities by examining our own infrastructure and policies within the patients' life and perspective.1

We can listen more closely to the patient's story and see their life challenges through new eyes. We can work toward a greater understanding of what lies beneath the culture of inequity-woven into economic and health experiences that are interrelated. Dr Kedar Mate,5 president/chief executive officer at the IHI, tells us we cannot achieve safety or high-quality care for all without these additional aims. He predicts that making equity the fifth aim will radically accelerate improvement in population health, enhanced care experience, cost reduction, and improved workforce safety and well-being. Without equity, we will miss the mark for health care for populations that are marginalized, underresourced, disenfranchised, and historically oppressed.5 I agree with his predictions and know that using the 5-part aim will guide us toward a different and better future.

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